You walk into a steakhouse. You’re hungry. You want meat. You ask the server, “Hey, how much is the ribeye?” And they say:
“We won’t know until after you eat it. And maybe not even then—it depends who’s paying.”
You’d be tempted to flip the table and leave, right?
So why does healthcare pricing remain a mystery—where nobody knows what surgeries, tests, and treatments cost until it’s too late?
Trying to find out the price of a simple medical procedure is like trying to get your cat to explain its feelings. Everyone shrugs, blames someone else, and you’re left with a bill that feels like it was made up by spinning a giant wheel of misfortune.
It’s a system that keeps you in the dark. But that doesn’t mean you’re powerless. Understanding why price transparency is broken—and how to work around it—can help you protect your wallet, your employees, and your business. Let’s break this down. No fluff. No jargon. Just real talk.
Why It’s So Hard to Get a Straight Answer on Healthcare Costs
You’d think healthcare would come with a clear price tag—like a menu or at least a ballpark estimate. But that’s rarely the case. For years, hospitals and insurers have operated within a system that makes it incredibly tough to understand what you’ll actually pay.
Here’s why it’s so confusing:
- Chargemaster rates: This is the hospital’s list price, which tends to be highly inflated and doesn’t reflect what most people actually pay.
- Negotiated rates: These are the behind-the-scenes agreements between hospitals and insurers. They’re not typically shared with patients, which makes it hard to comparison shop.
- Your final cost: This depends on how your insurance processes the claim—based on your deductible, out-of-pocket max, and plan coverage. Even hospital billing departments often can’t give you a clear answer upfront.
If you’ve ever tried to get a cost estimate—for something like knee surgery—you’ve probably been passed back and forth between your hospital and insurance provider with no clear answer. It can feel like being stuck in a revolving door.
A Step Toward Transparency… That Still Leaves You in the Dark
The Hospital Price Transparency Rule requires hospitals to post their prices online, which sounds like progress. But in practice, what you’ll often find are complex spreadsheets filled with medical terms and pricing ranges that are hard to make sense of without a medical degree—or a lot of patience.
Insurers also have to share pricing data, but it’s typically buried in huge data files that are nearly impossible for the average person to read or use.
So technically, the information is out there. But accessing and understanding it is still a major challenge.
Why This Matters—Especially for Employers
This lack of clarity doesn’t just affect patients—it affects businesses, too. As an employer, you invest in health benefits so your team can stay healthy, productive, and supported. But when employees can’t figure out what care will cost, they may:
- Delay or avoid necessary treatment
- Accidentally choose more expensive options
- Avoid using their benefits altogether
That means you’re spending thousands—maybe millions—on benefits that nobody’s confident enough to use. Part of the reason employers offer employee group health plans is that they help keep employees healthy, which means you can rely on them to show up and do their jobs. Another part of the reason is that your employees feel taken care of and want to stay with you. That doesn’t work so well if the benefits you offer make your staff feel frustrated, resentful, and angry.
Opaque pricing leads to confusion, frustration, and missed care—all of which take a toll on employee well-being and company morale. The more we can push for clarity and simplicity in healthcare pricing, the better we can support people in making informed, confident choices about their care.
Okay, So What Can You Actually Do About It?
First: stop playing the insurance company’s game. There are ways to push back and win.
1. Find an Independent Advisor (One That’s Not Married to Big Insurance)
Not all benefits brokers are the same. Some work for the insurers. You don’t want those. You want the kind who rolls up their sleeves, digs into your plan, and finds smarter ways to offer care. Independent employee benefits insurance brokers aren’t beholden to their insurance employers. Their only goal is finding the best, most cost-effective plans for their clients, not reaching a quota or getting a bonus from an insurance company based on how much they were able to upsell small business owners.
A good advisor will:
- Find plans that show real pricing.
- Help you negotiate better deals (yes, even cash-based options that cut out insurance middlemen).
- Educate your employees, including teaching them how to actually shop for care.
Yep—shopping for healthcare is a thing. But people need to know how to do it.
2. Use Plans That Offer Cash Deals or Transparent Rates
Some plans now offer straight-up pricing. Like, real numbers. Upfront.
For common procedures, you can sometimes pay cash—yes, actual money, not insurance voodoo—and walk away spending less than if you went through your plan. It sounds wild, but it works.
3. Train Your Employees to Ask Smarter Questions
You don’t have to turn them into health insurance nerds. Just arm them with basic stuff like a few helpful questions that can save them hundreds or even thousands of dollars:
- Is this in-network for my insurance?
- Can I get a breakdown of expected costs ahead of time?
- Are there alternative locations or outpatient centers with lower rates?
Those questions can give them the clarity and confidence to save themselves tons of money and stress.
What Employers Should be Doing
If your current broker just shows up once a year with a boring binder and a fake smile, you need to rethink that relationship.
You want someone who’ll fight for you. Who helps you build a plan where your employees actually know what they’re getting.
Options like direct primary care, reference-based pricing, and level-funded plans all prioritize transparency. They create cost certainty for your business and simplify the experience for your team. If you don’t know what those are, that’s fine. You don’t need to, yet. Your employee benefits insurance broker can help you wade through the buzz words and jargon to understand your options.
Be That Annoying Customer
You wouldn’t buy a TV without knowing the price.
You wouldn’t rent an apartment without knowing the rent.
You shouldn’t have to gamble every time you see a doctor.
Start asking questions. Expect answers. And if your current plan, broker, or provider can’t give you clarity? Move on and find someone who can.